European Spine Journal

, Volume 26, Issue 5, pp 1470–1476 | Cite as

Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study

  • Rahul Kaul
  • Harvinder Singh ChhabraEmail author
  • Alexander R. Vaccaro
  • Rainer Abel
  • Sagun Tuli
  • Ajoy Prasad Shetty
  • Kali Dutta Das
  • Bibhudendu Mohapatra
  • Ankur Nanda
  • Gururaj M. Sangondimath
  • Murari Lal Bansal
  • Nishit Patel
Original Article



The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries.


Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation.


Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems.


Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.


AOSpine Thoracolumbar Spine Injury Classification System TLICS Reliability Thoracolumbar spine injuries 


Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Supplementary material

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Supplementary material 1 (PDF 1251 kb)
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Supplementary material 3 (DOCX 23 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Rahul Kaul
    • 1
  • Harvinder Singh Chhabra
    • 2
    Email author
  • Alexander R. Vaccaro
    • 3
  • Rainer Abel
    • 4
  • Sagun Tuli
    • 5
  • Ajoy Prasad Shetty
    • 6
  • Kali Dutta Das
    • 2
  • Bibhudendu Mohapatra
    • 2
  • Ankur Nanda
    • 2
  • Gururaj M. Sangondimath
    • 2
  • Murari Lal Bansal
    • 2
  • Nishit Patel
    • 2
  1. 1.Department of OrthopedicsFlt. Lt. Rajan Dhal, Fortis HospitalNew DelhiIndia
  2. 2.Indian Spinal Injuries CenterNew DelhiIndia
  3. 3.Department of Orthopaedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman InstituteSidney Kimmel Medical Center at Thomas Jefferson UniversityPhiladelphiaUSA
  4. 4.Klinik für Querschnittgelähmte, Orthopädie und Rheumatologie, Klinik Hohe WarteKlinikum Bayreuth GmbHBayreuthGermany
  5. 5.Florida Spinal Surgery CenterMiamiUSA
  6. 6.Division of Orthopaedics, Trauma and Spine SurgeryGanga HospitalCoimbatoreIndia

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